Provider Demographics
NPI:1841036902
Name:VAVRECK, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:VAVRECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11259 69TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4576
Mailing Address - Country:US
Mailing Address - Phone:320-295-0196
Mailing Address - Fax:
Practice Address - Street 1:1018 5TH ST SE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1300
Practice Address - Country:US
Practice Address - Phone:320-402-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health